Diabetes is responsible for a huge and growing burden of patient suffering and social costs, and the impact of this disease is shared disproportionately by minorities and in rural resource-challenged communities. In particular, the Alabama Black Belt and the Mississippi delta have the highest rates of diabetes and obesity in the United States. The need for research targeted to rural populations characterized by a heavy preponderance of minorities and low socioeconomic status is acutely needed to better understand the basis for health disparities and to identify effective interventions for diabetes treatment and prevention. With this revision application, the UAB Diabetes Research Center (DRC) re-dedicates our center to improving the health of our patients with diabetes in the Deep South. To extend our scientific reach, we will establish a primary care clinical network in rural Black Belt counties of Alabama and in the Mississippi delta as a research resource that will provide the DRC and its members with opportunities for partnership and the infrastructure to conduct translational and clinical research in those patients with the greatest need. Our specific aims are: Aim 1: Establish a Diabetes Primary Care Coalition in the rural Black Belt region of Alabama. Building upon ongoing projects, we will establish a network of primary care clinics in rural Alabama and eventually expand to the Mississippi delta as well. The coalition will feature sustainable partnerships, engagement of community health workers, and a telehealth system for communication with primary care clinic personnel, education, messaging with patients, and data capture adapted to medical records systems. Aim 2: Integrate the Primary Care Coalition and clinical network as a research resource in the DRC. The clinical network will be facilitated by the Interventions & Translation Core, and the resource will be accessible to all investigators in our DRC as well as others in our partnering centers and academic institutions. Other DRC cores will be adapted to facilitate effective hypothesis testing using this resource. Aim 3: Conduct a pilot study of an innovative lifestyle program (telehealth + community health workers) with and without metformin for diabetes prevention. This pilot trial is intended to consolidate and refine operations within the primary care coalition, and to develop data for a larger scale randomized trial evaluating a novel and sustainable approach for diabetes prevention that involves an innovative lifestyle intervention combined with metformin. The current revision application underscores the commitment of the DRC to partnerships and research that is directed at improving health in patients with diabetes and cardiometabolic disease in our communities with a particular emphasis on health disparities in rural communities. The primary care coalition is designed as a powerful resource for the study of mechanisms responsible for chronic disease disparities and developing interventions uniquely effective in these high-risk populations.